A. Causes of chronic kidney disease
1, kidney lesions: various chronic glomerulonephritis, chronic interstitial nephritis, kidney stones, polycystic kidney, etc.
2, urinary tract obstruction: such as prostate hypertrophy, prostate tumors, etc. Systemic diseases and poisoning: hypertension, heart failure, diabetes mellitus, systemic lupus erythematosus and heavy metal (lead, cadmium, etc.) poisoning, etc.
In China, the common causes of chronic kidney disease are: nephritis, hypertensive kidney damage and diabetic nephropathy in that order.
Second, nutrition treatment
1, an important and indispensable part of the modern disease clinical integrated treatment program.
2, according to the characteristics of the disease, can be given to the patient to develop a variety of different dietary formulas, by enhancing the body resistance, promote tissue repair, correct nutritional deficiencies, to achieve the purpose of supporting the diagnosis and auxiliary treatment.
3. The nutritional treatment of chronic kidney disease has a history of more than 130 years, and active and effective nutritional treatment is essential to alleviate the symptoms of uremia, delay the progress of chronic kidney disease and improve the quality of life of patients.
The purpose of nutritional therapy for chronic kidney disease
1.Delay the progression of kidney disease and postpone the start of dialysis.
2.Reduce toxins in the body, reduce clinical symptoms and improve the quality of life.
3.Correct various metabolic disorders and reduce complications.
4.Improve the nutritional status, increase the survival rate and improve the quality of life of patients.
It is vital to limit protein intake in chronic kidney disease: When the kidney function is normal, the protein in food is digested, absorbed and decomposed, some of the protein and amino acids are absorbed and used by the body to maintain the normal physiological function of the body needs, and some of them are decomposed to produce nitrogenous waste such as urea nitrogen, which is excreted out of the body from the kidneys. In renal failure, the ability of the kidneys to excrete these metabolic wastes is greatly reduced, so the protein catabolic wastes will accumulate in the blood.
The use of low protein diet can reduce the production and accumulation of proteolytic metabolites, thus reducing the high workload of residual kidney units, reducing glomerular hyperfiltration, and delaying the progression of glomerular sclerosis and renal insufficiency. Therefore, low-protein diet therapy is an important tool for non-dialysis treatment of patients with chronic renal insufficiency. Low-protein diet should try to increase the proportion of high-quality protein (50-70%) such as fish and milk on the basis of limiting the total protein. Wheat starch can be used instead of some common flour and rice.
Fourth, the harm of malnutrition
1, increase the hospitalization rate and prolong the hospitalization time.
2, poor clinical prognosis, heart failure, heart attack and other complications are serious and frequent.
3, the progression of renal function deterioration is accelerated, the survival period is shortened, and the relative risk of death increases by 0.4 for every 1g decrease in serum albumin.
4.After entering dialysis with malnutrition, the mortality rate will be significantly higher than that of patients with good nutritional status.
V. Dietary treatment that should be taken by hemodialysis patients
1.Protein: normal protein diet: 1.0-1.2 g/kg/day, because amino acids will be lost in the dialysis fluid and increased decomposition, and adequate calorie intake: 30-35 calories/kg body weight/day. It is recommended that patients with poor appetite, malnutrition and inadequate dialysis should apply Kai Tong.
2. Hydration: The assessment of hemodialysis water clearance is accurately assessed to determine the appropriate dry weight of.
The water load status of the organism, blood pressure, weight changes, cardiac function, urine output, online blood volume monitoring, and water clearance after the absence of symptomatic hypotension. Dry weight should be assessed and adjusted monthly. Appropriate weight gain between dialysis periods, <3% of dry weight.
3. Phosphorus: phosphorus intake is closely related to protein intake Phosphorus intake: 800-1000mg/d, but can affect the nutritional status of dialysis patients, low phosphorus and low potassium milk powder is the current recommended food. Each dialysis can remove 800mg of phosphorus, as extracellular fluid phosphorus accounts for only 1% of the body’s total phosphorus, phosphorus redistribution after dialysis rebound elevated, only a transient reduction, can not really control hyperphosphatemia. It is necessary to use phosphorus binding agents.